# COMMONWEALTH BIOMEDICAL RESEARCH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982737961
- **Authorized official:** MRS. CAROLYN E WITTMER (OWNER/PRESIDENT)
- **Authorized official phone:** (270) 825-8345

## Contact information

- **Practice address:** 240 AYER PKWY E, MADISONVILLE, KY 42431-8999
- **Practice address phone:** (270) 825-8345
- **Practice address fax:** (270) 825-2975
- **Mailing address:** 240 EAST AYR PKWY, MADISONVILLE, KY 42431-8999
- **Mailing address phone:** (270) 825-8345
- **Mailing address fax:** (270) 825-2975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 1744R1102X | Research Study Specialist | — | NULL | — |
| 1744R1102X | Research Study Specialist | — | — | — |
| 207Q00000X | Family Medicine Physician | 34849 | KY | Yes |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | 5766P | KY | — |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 04/24/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000599550 | ANTHEM | — |
| 01 | — | 000000599551 | ANTHEM NP | — |
| 01 | — | 18D0994667 | CLIA | KY |
| 05 | — | 6434849300 | — | KY |